### 3026155 8 Superfun d 

## TRANSMITTA Lof OMAHALEAD SIT E SOI LREMEDIATIO NFIL EFOLDER SAID* : yy'i^. ^ Date: f//ff// / Address : . f NU / ZI l^'ZT T 

### Remediatio nContractor : _Coasta l Environmenta l Group

_Year : ZA ? i ( SOI LREMEDIATIO N PROPERTk ' FIL EFOLDE RDOCUMENT S D Vide o o f propert y (DVD ) \.L y Executiv e Summai y xy EPA-providedproperty skeich y Signe dAcces s Agreement fo r

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## xy Photographs ho . iS(£^i^J^. ^ p-{C^^J^ ^ SW ) "^yy As-built sketch ^y Satisfactor y restoratio nsignedb y Propert y Owne r '^y^ Propert y close-out check lis t signedb y EP A -S-
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## On : l o / I C / U By : nVideo/Photo s (During ) On : / / By : nVideo/Photo s (After ) On : / / By : D Video/Photo s (30-Day ) On : / / By : H Propert y Completio nAgreemen t Signed : < \/v « /\ v By : nFina l Repor t Issued : / / By : Ai r Monitorin g (a s applicable ) O Communit y O Cre w On : / / By : 

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O PLANNIN G DEPARTMEN T 181 9 FARNA M ST#111 1 OMAH AN E 68183-000 0 Propert yInformatio n Ke yNumber : 1155 000 0 1 9 Accoun t Type : E xGovernmen t Parce l Number : 191155000 0 Parce l Address : 1144 N17S T OMAH AN E 68102-000 0 Lega l Description : OMAH ABLD G & SAVING S ASS N AD D LO T3 0 BLOC K0 2 5 X 14 0 Valu e Informatio n Lan d Improvemen t Tota l 201 1 $0.0 0 $0.0 0 $0.0 0 201 0 $0.0 0 $0.0 0 $0.0 0 200 9 $0.0 0 $0.0 0 $0.0 0 200 8 $0.0 0 $0.0 0 $0.0 0 200 7 $0.0 0 $0.0 0 $0.0 0 200 6 $0.0 0 $0.0 0 $0.0 0 Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 8 3500. 0 0. 0 140. 0 25. 0 Ye s

5/31/201 1 1:3 8 P M lof 2

# IVs-Built Drawin g ^ OLS#:2549 9 DAT E EXCAVATED : 8/11/1 1 DAT E USEP ASIGNE D OF F : 9/22/1 1 ARE ASODDE N :208 0 

## COASTA L 

# Omah aLea dSuperfun dSite Environmenta l Group , Inc . 

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## n D Date : I I -2. qI O RPZ6CPX A -P Z pp m 

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### CONTRAC T# : EP-R7-09-0 6 COASTA L ENVIRONMENTA L GROUP , INC .

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### C^oiuS'tiii i io i I'A-.r.iii-.y : 'i o |-!:)|j>H(t y RIGH TO F EK H RYT O PREMISE S 

### Gianto i (th e piopert^ ' OH'nei ) consent s t o en d authorize s th e l/nile d Slate s Environmenta l Protectio n Agenc y(EPA ) o i it s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n enviionrnenta l respons e activitie s upo n th e followin g describe d premises : -N^ , ( y ) ^ 

# 9 Owner' s Nam e Dzylim e Phone : 

# ...OLQ i
Addres s o fPropert y covere d b ythi s Agreement : 

# \ y 

# 1 1 M aid\- l ?r t PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EP Ai s requestin g acces s t o collec t soi l sample s an d remov e soi l tha t contain s elevate d concentration s o flea d an d ma ypos e a healt h hazard . Th e area(s ) wil l b e excavate d t o remov e contaminate d soil . Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o it s origina l condition . Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o fCoasta l Environmenta l Group , contracte d b yUSEPA , wil l contac t th e Granto rin-perso n t o discus s th e wor k t o b e performed , th e Granto rwil l hav e a n opportunit yt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins . Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval . Upo n completion , th e Granto rwil l receiv e writte n documentatio n fro m EP Atha t th e propert y ha s bee n remediated . ENVIRONMENTA L RESPONS E ACTION S 

### B ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , its employees , contractor s an d subcontractor s th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o fperformin g th e wor ^

Thi s acces s shal l remai n i n effec t unti l th e wor k ha s bee n satisfactoril ycompleted . Th e Granto rals o agree s to :
Pag e l o f 2l ^^•y / c C. C AJ 1 t 

### 1 Remov e obstruction s incluriin g bucls^ tiaileis , vehicles , picyscap e items , woo d piles , do g houses , etc : Remov e flowe rbulD s o i plant s iha i ll'i e Granto i o i ih e Granloi' s tenan t maywis h t o save ; Wate ran d maintai n replacemen t vegetation , includin g feiiilize rapplication , as necessary ' subsequen t t o a n initia l waterin g perio d b yEPA , ' Abid e b yhealt h an d safet yguidanc e provide d b yEPA , < I f th e propert yi s rented , assis t EP Ai n obtainin g tenan t approva l (o racces s t o th e property ' t o perfor m th e work . Allo wvideotapin g and/o rphotographin g o fth e property . AGREEMEN TNO TT O INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo fth e wor1 < activities , o i wit h an y o fth e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propert ywhic h woul d ten d t o endange rth e healt h o r welfar e o fth e Grantee s o rth e environment , o rt o allo wothers l o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquesiion s abou t thi s program , pleas e contac t Coasta l Environmenta l Group , a t (402 ) 991-119 9
^ I gran t zcces s t o m ypropertie s Q I d cnot grant acces s t o m ypropertie s 

# ..ycL..:zy/ . Dat e Signature Dat e
O I woul d lik e t o be presen t durin g an ysemplin g Ihs l i s required .

Pag e 2 o f2COASTA L ••Our , I »• c 

## Restoratio n Agreemen i Th e purpos e of thi s agreemen t i s to provid e amutua l agreemen t a s t o condiiion s o f ih e propen y prio r t

o remedialio nacliviiies . Thi s will als o ser\' e a s documentatio nfo r th e purpos e o f assurin g tha t restoratio n activitie s ar e complete dl o the salisfactio nofth e property owne r an dthe UnitedState s Environmental Protectio nAgency (EPA) .

Property ID : OS^^ Q Property ' Addres s Owner : 

# Ucko ^ / z CAmayo \ Phone : O

nth e attache ddiagram(s ) indicate area(s ) to excavate , surfac e structure s an dlandscapin g feature s and acces s location(s ) to b e usedby th e contractors . Indicate distances , depths , materia l types , etc . Pholographjcali y an dVideographicall y documen l the existin g condition s ofth e properly an dth e basemenl if necessar>' . Item s t o b e Remove d b yth e Owne rbefor e Star t o fRemediation : Th e removal , storage , disposal , and/o rretu m o f thes e item s i s th t Owricr' s responsibility . Ite m 

# NJQKlb " Item : Item : -7 * 

### Item :

Pag e 1 o f

### Item s t o B e Remove d B yContracto rDurin g Remediatio n an d Replace d

Ite m Landscap e Inventor y Quantit yUni t Condition/Type/Specie : Pre-exisiin g propert y area , tha i wil l be excavaied , tha i i s covere dwil hgrass . 

# <^A Quadrani s Numbe r of tree s > 2 inch trunk diameter Each Numbe r of tree s < = 2 inch trunk diameter Eac h Numbe r of Sprinkler Zones , Contro l Valves , Timers , Heads , etc . Attac hasketc ho f th e SprinkJe r layout . Each

Numbe r of andsiz e of eac hgarden/ flowe r bed area . Attac h a sketc h o f relativ e size s an d locations . Each Square Feet Agree dupo nvalu e ofplan i material s not to b e replace dbv contractor . Not e thi s valu e will b e use dto issu e aplan t vouche r to th e propert y owner . Easemen t Area , to be excavate d Eac h
Pag e 2 o fU O As 1 A1 .
Additiona l Comment s / Instructions : Th e cit yo f Omah a ordinance s ma yprohibi t yo u fro m usin g dir t o rgrave l area s o n you rpropert y a s driveway s o rvehicl e parkin g areas . Th e Environmenta l Protectio n Agenc y(EPA ) ma yb e removin g an d replacin g soi l underlyin g a grave l o rdir t are a o n you rpropert ytha t yo u ma yb e usin g o S s drivewa yo rvehicl e parkin g area . I fthi s i s th e case , yo u shoul d understan d tha t thi s removin g an d replacin g o f soi l doe s no t mea n tha t an yillega l drivewa yo rparkin g are a o n you r propert yi s mad e legal . T o th e contrary , yo u ma yb e cite d b yth e cit yi fyo u us e a grave l o rdir t are a a s a drivewa yo rparkin g area , no t withstandin g an yremova l o rreplacemen t o fsoi l b yth e EPA . I f yo u hav e an yquestio n abou t legalit yo fa certai n drivewa yo rparkin g area , yo u ma ycontac t th e cit yo f Omahc' s Plannin g Departmen t at (402 ) 444-5150 . Pleas e chec k thi s bo xi f yo u understan d th e informatio n outline d above .

vsoChec k th e bo xi f Owne rdoe s no l wan t CE G l o documen l interio rfoundalio n wall s an d possibl e 'pre-existin g damage . B ycheckin g thi s bo xCE G i s no t responsibl e fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n crack s o rfissures . Q I d o no t agre e

Dat e Pag e 3 of . 

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Shot # Readin g RETES TAREA S Sampl e are a Dept h Shot * Readin g Sampl e are a Dept h Averag e Signature_ 

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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

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pp m P b 91.51 5 Supervise d By : 

## Certificat e o fVerificatio n

4 Soi l 2011-08-1 6 16:2 5 90.5 2 pp m 2 Fina l Av g o f 1- 3 114 4 n 1 7 s t B 2 10 " KIN G confirmatio n confirmatio n
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# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

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pp m P b 100.58 8 Supervise d By : 1 Soi l 2011-08
­ 30.2 0 pp m 2 Fina l 

## Certificat e o fVerificatio n

1 6 16:2 3

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±Erro r ±17.37 7

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 96.78 1 Supervise d By : 

## Certificat e o fVerificatio n

2 Soi l 2011-08-1 6 16:2 4 30.2 0 pp m 2 Fina l 2549 9 114 4 n1 7 s t B 2 10 " KIN G confirmatio n confirmatio n

±Erro r ±17.01 8

# Therm o SCIENTIFI C Therm o Fishe rScientifi c 90 0 Middlese xTurnpik e Billerica , M A0182 1

XL3t-3902 2 Readin g N o Mod e Tim e Duratio n Unit s Sigm a Valu e Sequenc e Flag s BVI D ADDRES S QUADRAN T DEPH T XR F TEC H MIS C NOT E
pp m P b 77.17 7 Supervise d By : 

## Certificat e o f Verificatio n

3 Soi l 2011-08-1 6 16:2 5 30.1 2 pp m 2 Fina l 2549 9 114 4 n1 7 s t B 2 10 " KIN G confirmatio n confirmatio n

± Erro r ± 15.91 4X ,1E U »r< . 

## Omah a Lea d Site—Fixe d Pric e EP-R7-09-0 6 Coasta l Environmenta l Grou p Inc . V • .^* www.coastalhazmat.co m

^-'Lp^o- yCOASTA L ENVIRONHENTA L GROUP . IN C 

# EXECUTIV ESUMMARY : BVID #25499-(1144 N1 7 ST ) N o Issue s o r Concern s | ^ Issues/Concern s Detail Explanation :

### ' « * 

## Propert yCompletio n Agreemen t Thi s agieemen i documeni s th e completio n o f remedia l aciivme s perCoimc d n n m yproperty . M ysignaiui e wil l designat e lha t 1 a m satisfie d wit h ih e restoralio n ofm yproperly , an d Iha l n o item s ar e i n questions . now . o rat an ytun e i n th e future , excep t thos e item s liste d below , i fan y

PropertylD : '^^^vj^e^ o Piopcrr^ ' Address : VV^V J V i \- > -ft x Owner : ^,^ ^ ^ ^ 

### V^lk^V v Phone : v^o^-^^^V ^ Restoratio n Item s i n Question :

Item : Item : Item : Item : Item : Item :

/ ^ l 1 ayrc cifstoralio n i < compieled , excep t a s nottr i [ I I rto no t ai;re crestoratio n i s complete d 

# ^

iryjyyo' 7 

# syy y y y Dat e ontraclor' s Sifrnalur t Dat e

## EF A Propert y Clos e Ou t For m IJ<A V K ) 1 1 5T ^ Proptrt y *l : _^T j / / Propert y Atldrtss : —•-;j ; TT-JS——- r Dtte/Tlrot : " Owner' s Ntni e Qiitd s Exrcvsird ; (3L3- _ Contrtclo r Grou p Ve s N o LriCbVBtlo D Gencrt I 1 . If necessuy , wer t th t correc t qiiadrant(s ) excavEte dendreslored ? / 2 . If necessa^ , were Ih e corrtc i srea s ofdri p zon e excavate dan dreslorfd ? 

# y Grtdlo g So dtn dVfnetallo c Y « N o Doc s the {;rBdin g aroun dthe pcrimclc r ofth e hous e i nexcBvaier i arcs s generally slop e awa y . I 1 fromtb e house ? 2 . HK S so dbee nlai di n all area s that -wer e escavsted ? 

# y i Doe s th e sodappear to b e generall y health y an dgrowing ? (Onl y evaluate i f insprrtr da t s 3 0 da y lime period ) 

# y L

- 'i . Ar t sodde darea s generall y fir mandevenl y graded ? 

# y 'i Ar e thejoint s beM'et nth e so dstrip s generall y tight ? (Onl y fvaluat t i

f inspecte da t J } 0 da y ! ^ lim e period ) I 6 . Wa s th t propen y grade dsuc hthai waier u-D l noi poo l (i nihc prnperty' ' 

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# y 7 . Wa s damag e l o landscapin g o r plant msterial s avoided ? 

# "y . Gates . Fence s an dRetsinln g Wall s 

# r -^-•7\- ~ D o gate s ope nandclos e freely? (Ifappiicabie ) , rI 2 . Wer e all gate s o r fence s laJje ndONv ndurin g restoratio nactivitie s reinstalled ? (II applicable ) /

.- . Wa s damag e t o gate s o r fence s avoided ? (If applicable ) 

# y 4 . Wa s damag e to retainin g wall s avoided ? (I f applicable ) 

# izr: i Foundatioa , Sidta g an dGatter s V« 4 .N o I . Wa s dainag e l o th e sidin g o r tri mavoided ? / 2 . Wa s damag e t o ihe foundatio navoided ? ? . Wa s damag e to window s avoided ? 

# 7 4 Wa s damag e to window s o r doo r saeen s avoided ? / Wa s damag e t o downspout ; o t downspou t extension s avoided ? 

# .. A Sidfvialk s an dDriveway s (Concrete ) Ye s N o 1 . Wa s damag e t o driveway surface s avoided ? 

# 7h2 . Wa. s damag e t o walkway surface s avoided ?

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